Confusional state is a common disorder in geriatric inpatients in general hospital. The diagnosis of this disease in the elderly is especially difficult due to imprecision of clinical. It is a hard challenge both to specialists non psychiatrists and even psychiatrists. Delirium often is misdiagnosed in 30–50% inpatients and on admission.

To compare the rate of misdiagnosis of delirium in the elderly by a psychiatrist and general medical personnel.

Interview of physicians and nurses of the general medicine and traumatology units to identify inpatients 65 years old and older with delirium diagnosed by the respondents. Subsequent screening of all the inpatients of 65 years old and older by a psychiatrist for delirium detecting.

The rate of delirium misdiagnosis in the traumatology unit was 28.6%. Overdiagnosis of delirium in the general medicine unit was 22.2%. Incorrect diagnoses of delirium by specialist psychiatrist was 8.7%.

Satisfactory results of diagnosis of delirium provided by specialist psychiatrist are caused by combination of clinical assessment of anamnesis and present state by skilled psychiatrical survey and usage of standard psychometric scales. The results of diagnosis by specialists non-psychiatrists primarily are caused by their insufficient in-depth knowledge in delirium. It confirms high demand in comprehensible and rational diagnostic schemas for general medical staff, for providing basic psychiatry knowledge for them and more active usage of standard psychometric scales by specialists non-psychiatrists and especially nurses to improve their recognition of mental disorders.

Arachnoid cysts (ACs) are intra-arachnoidal space occupying lesions, typically of a benign and congenital nature. They reportedly occur in more than 1% of the population, and are usually considered incidental when found in people with psychiatric symptoms. However, some authors argue for a putative causal relationship, based mainly on reports of improvement of a co-existing mental condition after surgical decompression of a cyst.

We describe a patient with schizophrenia-like psychosis and a temporal AC.

We will argue for the possibility of an association between the AC and psychotic symptoms.

We used a multidisciplinary approach to the patient, with emphasis given to diagnosis and treatment. We also reviewed the literature on the association between AC and psychosis.

We describe a 46-year-old woman with schizophrenia-like psychotic symptoms and visual hallucinations, refractory to antipsychotic treatment (including clozapine). Magnetic resonance imaging revealed a volumous AC with mass effect on temporal parenchyma. The patient was considered eligible for possible removal of the cyst, but refused to consult with a neurosurgeon.

The meaning of ACs found in patients with psychosis remains controversial. in our case, the lesion's volume and mass effect, the involvement of a region with a central role in the pathophysiology of psychosis, and the refractoriness to clozapine treatment, all argue for a causal role in the patient's psychosis. Surgical decompression might have improved the patient's outcome. Yet, the lack of a solid evidence-base made it ethically unacceptable to advocate for this option in a reluctant patient.

PCOS is a syndrome of the heterogeneous nature, affecting multiple systems, particularly the endocrine system. We propose to investigate the possible relationships among hormonal changes, levels of anxiety, depression, and anger in patients with PCOS.

Fourty four female patients with PCOS and 44 BMI (Body Mass Index)-matched healthy women participated in this study. We measured the sociodemographic features, some serum hormonal levels (insulin, gonadotropins, prolactin, dehydroepiandrosterone sulfate (DHEAS), TSH, T3, T4, 17 OH-Progesterone, total and free testosterone) and some other biochemical parameters of the participants. Also, all participants completed Trait Anger-Anger Expression Scale (STAS), Beck Depression and Beck Anxiety Inventories.

The mean ages of the patients with PCOS and control subjects were 27.3 ± 5.6 and 27.4 ± 6.1 years, respectively. The measures of BMI, insulin, LH, DHEAS, and total testosterone serum levels in the patient group were significantly higher than the control group (p < 0.05). There was statistically significant positive correlation between BAI scores and DHEAS levels. We found significant differences between two groups in terms of trait anger, anger control, anger outward and inward, anxiety level and depression scores (P < 0.05).

Anxiety symptoms indicate stronger relationship compared to the depression with the DHEAS serum levels via autonomic nervous system, considering GABA antagonistic effect of DHEAS. Obesity, hirsutism, and infertility may reduce selfconfidence, and create depressive symptoms in patients with PCOS. in addition, changes in the hormonal levels may lead to anxiety directly. Possibly, depressive symptoms are a secondary reflection of these changes.

The symptoms of many mental illnesses often begin during high school. Interventions to improve mental health awareness amongst adolescents may lead to improved outcomes. in the UK unfortunately many schools do not fulfil this need and mental health education is not a compulsory part of the curriculum.

To develop and measure the effectiveness of and educational intervention designed to raise awareness and empower adolescents to recognise signs of poor mental health and access services appropriately.

Evaluate the effectiveness of the intervention through baseline and follow up surveys.

Students at Norwich Medical School collaborated with teachers, psychiatrists and general practitioners to design an educational intervention that aims to tackle stigma and raise awareness of mental health conditions among 13-14 year olds in the hope that they can access services when needed, support those around them and look after their mental health. To evaluate effectiveness of the intervention, a knowledge, attitudes and practices survey that utilises a social distance scale that has been adapted for this age group and will be used to gather baseline and follow up data after six months.

We have developed a one-hour educational intervention delivered by medical students, that uses a variety of teaching techniques to raise awareness of mental health issues. We will start implementation in January 2013 so will have baseline effectiveness results shortly after.

Headucate has the potential to fill an important gap in effectively raising awareness of mental health issues in schools.

Tramadol, initially introduced in Germany in 1977, is a synthetic analgesic and appears to have a dual mechanism of action; a weak μ-opioid receptor agonism and a reuptake inhibition of serotonin and noradrenaline. It is marketed in Tunisia since 2001. Generally, Tramadol is considered to have a very low risk of dependence and abuse, but rare cases of tramadol dependence have been described in patients without prior substance abuse history. We describe one such case in a relatively young, otherwise healthy patient.

Mr AR, a 47-year-old man, presented to get help with tramadol addiction. He had no previous history of illicit drug use, did not smoke cigarettes or drank alcohol.

Mr AR was started on tramadol treatment about 2 years earlier for back pain. He did have better pain control with tramadol, but he gradually started taking more and more. Ultimately, his pain resolved but he was unable to stop taking tramadol: he was taking up to 1700 mg/d of tramadol and had made multiple efforts to stop. When he stopped taking tramadol, he had dysphoria, muscle cramps, anxiousness, restlessness, and a sensation of insects crawling all over his body. His withdrawal symptoms were severe enough to interfere with his work and family life.

Tramadol dependence is very rare but can happen in a patient without substance abuse history. We, as medical practitioners, should be open to the possibility of tramadol dependence and should resort to optimal and judicious use of such a substance.

The pathogenesis of schizophrenia is still unclear. Genetic, biological and environmental factors are thought to intervene. It is known that schizophrenia is characterized by a difficulty to express one's feelings and identify other persons’ feelings (theory of mind) and so does alexithymia which is a psychosomatic concept.

To compared patients with schizophrenia with patients presenting a disease that is classically considered as a psycho-somatic disease: asthma.

Thirty-nine patients with schizophrenia (group S) and thirty nine sex and age matched patients with asthma (group A) were assessed by the same psychiatrist using the 20 items-Toronto Alexithymia Scale validated in Arabic.

The mean alexithymia score in group A was 70, 45 versus 68,44 in group S, with no statistically significant difference.

The prevalence of moderate alexithymia (score superior to 60) was 22, 6% in group A and 37, 5% in group S, with no statistically significant difference.

The prevalence of severe alexithymia (score superior to 70) was 57% in group A and 26% in group S. Difference was statistically significant (p = 0,003).

This study showed that severe alexithymia was significantly higher in patients with asthma compared to patients with schizophrenia. Nevertheless, the high prevalence of moderate alexithymia in patients with schizophrenia shows that alexithymia should be taken into account when treating a patient with schizophrenia, and a psychotherapy addressing this issue would be helpful.

Dependence caused by motor impairment negatively impacts on the quality of life.

1. - To assess the quality of life in people with motor disabilities

2. - To identify the most impaired quality of life domains in our population

3. - To describe the advantages as well as the limitations of using the WHOQOL-100 scale in our context

We carried out an epidemiological, cross-sectional and descriptive study in a population consisting of 60 consenting patients aged over 18, suffering from major motor disabilities. The following questionnaires were administered:

1. - A sociodemographic and identification questionnaire.

2. - A questionnaire designed to explore and characterize the motor disability.

3. - The WHO quality of life questionnairein its full 100-item version (WHOQOL-100).

Sixty people aged from 16 to 87 years were included. Only 8% were legally recognized invalid and received a disability allowance. Approximately one third of subjects did not have any health insurance, 53% of subjects lived at home and 47% lived in institutions. The overall mean score of quality of life for all domains ranged between 46.63 and 74.9. All domains of quality of life were altered except for spirituality. The level of impairment was comparable to that in stroke or in end-stage renal disease. The domain with the lowest score was sexual activity.

The quality of life of disabled people is multifactorial; it often entangles with many variables, especially the severity of the disability, the place of residence and the possibly associated depression.

The aim of our study was to determine the prevalence of depression in diabetic patients who consulted the Tunisian National Institute of Nutrition and to assess risk factors and clinical features of these disorders.

Cross-sectional study including a population of 100 diabetic patients. A form was designed for epidemiological data collection. Depression was measured using the Hamilton Depression Rating Scale (HAMD).

Our results showed a high prevalence of depression in diabetic subjects. 51% of diabetic patients have moderate to severe depression, 13% had mild depression, while 36% had normal values on the HAM-D. Moderate to severe depression was present in 37% of men and 42% women.

Diabetes is associated with a significantly increased risk for depressive symptoms. Our study confirms the usefulness of the assessment of depressive symptoms during follow-up of diabetic patients and the importance of an early multidisciplinary care. Pathogenetic mechanisms connecting diabetes with depression deserve further exploration.

Aging is a natural and inevitable process leading organizations live to change over time after the phase of maturity. His progress is highly variable from one individual to another. So that the old population is very heterogeneous. But this heterogeneity is also and especially due to the very high frequency and diversity of chronic diseases in this population.

The aim of our study was to evaluate the different patterns of psychiatric consultations in the elderly.

This is a retrospective study conducted in the outpatient hospital razi, involving 90 patients aged consultant during 2011.

In total, 90 cases were recorded. The average age of patients was 77.5 years.

The sex ratio (M / F) was 1.04. The majority of consultants had an iron status of married (51.1%) and widowed (41.1%). 77.8% of patients were illiterate. 63% of patients were retired and 49% of cases were low socioeconomic level. Personal psychiatric histories were found in 12% of consultants. The two reasons for consultation were the most common symptoms of depression (sleep problems, headaches, food refusal, sad mood, psychomotor retardation, somatic complaints) and behavioral disorders with 50 and 42.2% of cases.

The prevalence of psychiatric disorders is important in the elderly because half of those over age 65 suffer from a psychiatric disorder.

To study “Quality of Life” (QOL) features in MVP patients suffering anxiety disorders.

We examined 290 MVP patients and 73 healthy subjects.

30 patients received medication with alprazolam within 10 weeks.

18 patients attended courses about rational-emotive therapy (16 sessions, individual assessments).

Psychological and clinical examinations of the patients were made before and after psychotherapy courses and medication. Psychological testing embraced the assessment of anxiety indicators (Spilberger Scale); and QOL indicators were assessed through the Ryff Scales of Psychological Well-Being, the Visual Analog Scale (VAS) - the “health” dimension, and the Disability Scale (DISS) - the dimensions of “work,” “social life,” and “personal life.”

MVP patients are distinguished from healthy subjects by lower rates of QOL indicators, and increased anxiety.

A significant reduction in anxiety were found, as well as increase in QOL indicators after medication, and after psychotherapy. However improvement of QOL indicators was more expressed after psychotherapy.

Physical examination of the patients revealed a significant reduction in the frequency and intensity of panic attacks, chest pain, and thermoregulation disorders in both groups of patients, as well as the decrease of prolapse depth in all the patients after psychotherapy.

The research showed a significant improvement in QOL indicators, and also in a number of clinical symptoms in MVP patients suffering anxiety disorders after psychotherapy.

These results are important for the therapy and psychological assistance to MVP patients.

The purpose of the present study was to investigate whether deficits of behavioral or/and N400 semantic priming (SP) effect observed in patients with schizophrenia is a stable cognitive feature of the disorder or whether it may be influenced by the severity of the actual symptomatology that may fluctuate over time.

A Test-Retest one year study was conducted on fifteen patients with schizophrenia and 10 healthy participants who performed a SP task. Both behavioral measures and Event-related potentials (ERPs) of SP were recorded twice (Test and Retest sessions).

At Test, patients exhibited a deficit of SP as revealed by both the behavioral and the ERP measures (the amplitude of the N400 component). At Retest, behavioral SP remained impaired in contrast to the N400 SP which was significantly improved in relation probably to the patients' clinical improvement.

The results conveyed evidence that the N400 SP impairments in schizophrenia may not be considered as stable cognitive markers of the disorders. Significance: The behavioral and the N400 measures of SP had different level of sensitivity to subtle cognitive and brain processes which were subjected to change over the clinical course of schizophrenic disorder.

With aging, the risk of many diseases increases. The prevalence of somatic diseases in psychiatric patients is high. This comorbidity is more common that the subject is old.

The aim of our study was to determine the different somatic pathologies associated with various psychiatric disorders in the elderly.

This is a retrospective study conducted in the outpatient hospital razi, involving 90 patients aged consultant during 2011. The data were collected from patient records.

Ninety patients were found during the study period. The average age of patients was 77.5 years. The sex ratio (M / F) was 1.04. The majority of consultants had an iron status of married (51.1%) and widowed (41.1%). 63% of patients were retired and 49% of cases were low socioeconomic level. Personal psychiatric histories were found in 12% of patients consultants. 51 patients (56.6%) had somatic pathology associated with psychiatric disorders.

Elderly patients' organic disease is unknown in most cases and is a causal or aggravating the mental disorder.

Type II diabetes is more common in patients with schizophrenia than in the general population. Although disorders of glucose metabolism have been described in patients with schizophrenia before the introduction of atypical antipsychotics, a diabetogenic effect of these has been implicated.

The aims of our study were to:

1. - assess the prevalence of diabetes in a population of patients with schizophrenia.

2. - determine the relationship between diabetes, atypical antipsychotics and schizophrenia.

This is a retrospective study of 60 patients with schizophrenia. Data collection was done based on patient records.

The majority of patients were male with a sex ratio of 2. The average age of our patients was 38 years. 40% of patients (25) had diabetes. 33% of patients were put under an atypical anti psychotic. The diagnosis of diabetes succeeded that of schizophrenia in 40% of cases.

Our results indicate that patients with schizophrenia are more likely to develop type II diabetes. We caution clinicians to consider the risk and be vigilant about this development.

To show the course of the disease and the clinical manifestation in schizophrenic patient, who during several annual treatment developed symptoms of Capgras syndrome and Mignon delusion.

72 year old female patient was admitted to the hospital due to deterioration of mental state.On admission in mental status dominated: accelerated opinion in form and in content with plenty paranoid ideas she also said: This is not my husband. Sometimes I know that this man wears a mask, so he looks like him, but my husband is not here he is in the U.S. Insight into previous medical records,showed that in the previous hospitalization she amounted symptoms of Mignon delusion and was saying that her parents were not hers and that she is a descendant of a noble family. It is Significant that those symptoms were followed after minor head injury.

Dynamics of changes in symptoms indicates the importance of further processing in order to determine whether these symptoms were result of underlying disease or may be caused by an organic lesion that is very often in the same substrate.

To study the features of interoception experience and pain perception in MVP patients.

The psychosemantic technique «Classification of sensations» was used. Testees had only 80 Russian words to describe their interoception experience and pain perception. They had to select words which can be used for the description of interoception experience; then it was necessary to choose consistently familiar sensations, the painful sensations, often felt sensations, and, at last, words which are suitable for the description «sensations in heart».

We examined 134 MVP patients and 73 healthy subjects.

MVP patients reliably distinguish (p< 0.05) from healthy individuals by fairly large amount of interoception vocabularies (see Table 1).

[Table 1.Interoception vocabularies (descriptors)]

Qualitative analysis of the results showed that the expansion of interoception vocabularies of MVP patients is due to inclusion of the words that describe the mental states and emotions.

Received results prove a role of psychological factors in an etiology of pain syndromes in MVP patients.

Suicide and self-injurious behaviour are one of the most common causes of consulting in the hospital emergency services. Most of the cases, are attempts made by intake of great quantities of drugs (drug overdosing).

Review of the drug overdosings attended in our Hospital emphasizing our interest in the presence of psychiatric history, characteristics of the attempt and case management.

Retrospective review of clinical histories of patients attended by the Emergency Service.

We identified 112 drug overdosings.

68'8% of the patients attended were women, being the most frequent age range from 31 to 40 years (33%).

80'4% of the patients collected had psychiatric history, being the most common diagnosis: Mood-Anxiety disorders 60'7%, Substance-Related Disorders 41'1%, Personality disorder 30'4% and Psychotic disorder 10'7.

Previous attempts were found in 43'8% of the patients.

The most common drug used were benzodiacepines (73% of the cases), followed by antypsichotics (17'9%). Up to 32'1% of the patients used non psychitrict drugs.

The most common diagnosis was suicide attempt (41'1%), followed by parasuicide attempt. 41'4% of the drug overdosings were not considered as self injurious behavior.

When we compared those diagnosed of personality disorder with the rest of the patients, we found that although they were more often diagnosed of parasuicide (50% Vs 32'1%), they needed more hospitalizations (41% Vs 21%)

Self-injurious behaviour are one of the most common causes of consulting in the hospital emergency services. Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.